OZONE.

By CHARLES E. QUIMBY, M.D.,

NEW YORK.

RECENT medical history affords few more instructive illustrations of unrestrained enthusiasm than may be seen in the
effects upon the therapeutics of phthisis of Koch's discovery of
the tubercle bacillus, coming as it did at the height of the
surgical antiseptic furor. Each man seized the antiseptic
nearest at hand and went forth assured that he was to slay the
great dragon of tuberculosis. It is more than surprising now,
as we recall the story, to see how utterly pathological obstacles
and physiological possibilities were overlooked or disregarded,
and what superfluous energies were wasted, in proving that
which should have been self-evident. Nor is it by any means
certain that the present almost universal use of creosote in
phthisis is not based largely upon a lingering belief in its
germicidal power. Generally, however, the reaction of medical
opinion has been so extreme that any expression of a faith in
local antisepsis in phthisis is almost sufficient to brand one as
a visionary. Before asking your brief attention, then, to some
questions relative to the use of ozone, I desire to make my
position on this point very clear and definite. Since I first
began a systematic study of phthisis I have seen no reasons to
justify any expectation, or even hope, that a specific cure for
the disease will ever be found, unless it be the product of the
defensive action of the living tissues themselves. I have denied
the possibility of destroying tubercle bacilli in situ by means
of any antiseptic at present known. I refer to an article on
the use of tubercuilin published in January, 1891, and to a

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paper read before this Association, to substantiate the claim

that mv therapeutic efforts have aimed to attack tuberculosis
and phthisis essentially through the systemic forces. Upon
such a basis abundant reasons have been presented that both
justify and demand the use of local pulmonary antiseptics, not
in the hope of destroying such bacilli as are contained in living
tubercle tissue, but solely against the sources of decomposition
and possible centres for fresh tubercle infection situated in the
pulmonary air-spaces or on exposed ulcerating surfaces. A
year ago my list of local antiseptics had narrowed, by processes
of clinical exclusion, to three-alcohol, creosote, and oil of
cloves. These were employed constantly in all cases of
phthisis, and, apparently, with very satisfactory results. It
should be said, however, that no one was ever tested except in
connection with other measures, and their specific values are,
hence, matters of personal judgment.
When, early in 1893, my attention was called to an apparatus
for generating ozone in quantity, knowledge of the properties
of that substance led me to undertake a careful clinical investigation of its value as a therapeutic agent. The utter inadequacy of that apparatus to perform the work promised and
required is responsible for the meagreness of the data upon
which this preliminary report is based. I should feel justified
in offering it by way of apology were it not that it has led to
a study of ozone apparatus, with results that are equally valuable, although very brieily expressed. I have now arranged
an apparatus which will fulfil all requirements, may be used
with either battery or dynamo current, supplying small or
large amounts of ozone without waste of power, and is comparatively cheap. I shall be pleased to supply any gentleman
with drawings illustratino the principles of its construction.
The powerful oxidizing properties of ozone render necessary
its consideration from a clinical standpoint under three heads:
1. As a tissue stimulant or irritant; 2. As a local antiseptic
and 3. As a source of systemic oxidation.
1. As a stimulant or irritant.
This action of ozone is placed first not only from its im-

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CHARLES E. QUIMBY,

portance as a therapeutic measure, but because the possibility

of avoiding undue irritant effects is a pre-requisite of its use for
any other purpose.
Assuming, as I do, that the direct curative agent in phthisis
is the local inflammation, any force capable of modifying this
process acquires thereby a definite therapeutic value. The
pathology of phthisis demonstrates that in a large proportion
of cases the reparative processes are adynamic in character.
The direct indication for treatment, in accordance with a wellestablished law of protoplasmic reaction, is the local application
of a so-called stimulant, which means irritant. It is the
principle upon which Koch directed the use of tuberculin, and
which I have followed from the first in the use of that remedy.
In an article bearing upon this subject which I had the honor
to present to this Association two years ago reference was
made to certain traumatic effects obtained by means of the
pneumatic cabinet and their causative relations to increase of
nutrition and reparative processes in the lungs.
It is in a similar class of cases, where degenerative or necrotic
changes are taking place as the result of defective circulation
and diminished tissue activity, a condition directly analogous
to that which upon exposed surfaces would indicate the application of an irritant or caustic, that the use of ozone inhalations to the point of distinct irritation has seemed to be of
most decided value. This conclusion is based on the general
results in all cases where ozone was given in connection with
the cabinet, and upon two cases in particular which were
treated by ozone inhalations alone. The first of these was a
young woman, aged twenty-two years, in the third stage of
phthisis, who had been treated for nearly a year by the cabinet
alone. Through the winter of 1892-93 she simply held her
own. In the late spring she began to gain, and when she
left the city in July a large apex cavity was almost entirely dry.
During the summer, in the mountains, she had an acute exacerbation of her disease. The cavity filled again and the
surrounding infiltration was increased. On her return for
cabinet treatment in November she was too weak to bear any

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335

differential pressure, even had I not feared the increased sepsis

which might follow any form of treatment other than that for
the removal of the septic material. She was, therefore, treated
solely by inhalations of ozone, of gradually increasing strength,
until they produced a decided sensation of warmth throughout
the lung and excited cough. The first treatment was on
November 14th. The diminution of expectoration was appreciable within a week, aind the increase of strength such that
the use of the cabinet was resumed early in December. Although this patient has gradually lost strength during the past
winter, there has been no repetition of the acute attack of last
summer.

The second case was a young woman, aged twenty-five years,

with consolidation at the left apex. The r&les were abundant,
heavy, and sticky, indicating commencing softening. The
sputum was characteristic, thick, tenacious, lumpy, and loaded
with bacilli. Treatment consisted of daily inhalations of
strongly ozonized air at a rarefaction of from 1.5 to 2 inches
of mercury. Results as in previous case. Strength increased,
cough diminished, and appetite improved. Within two weeks
there was no longer any cough at night, and at the end of a
month the patient said she had no cough and felt quite well.
This could not have been quite true, as she furnished a satisfactory specimen of sputum for examination. This sputum was
much less sticky, and auscultation revealed a proportionate
diminution and change of character in the rfles. No claim is
made that these cases are cured; on the contrary, it is known
that they are not. It is simply claimed that the changes noted
are such as would be expected from local stimulation, and,
therefore, may be attributed properly to the ozone inhalations.
My position on this point may be stated categoricallys:
a. It is an accepted fact that ozone is a most powerful
stimulant to mucous membranes.
b. That it may be so applied by means of the pneumatic
cabinet as to manifest this action deeply in the bronchial
tubes I have repeatedly demonstrated.
c. If the processes of nutrition and repair in the lung are

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CHARLES E.

QUIMBY)

subject to the laws governing similar processes elsewhere, then

the local application of a stimulant must be of value in all
cases of impaired local nutrition with or without ulceration.
d. Ozone, on account of its associated properties, is to be
preferred to all substances yet offered for such applications, and
its administration is rendered most effective by means of the
pneumatic cabinet, through the modifications produced in the
pulmonary circulation.
e. The clinical results confirm the accuracy of the foregoing
deductions.
Personally, I regard this stimulant action of ozone as one of
its most valuable properties.
2. Ozone as a pulmonary antiseptic.
It is evident that the irritant properties of ozone place limitations to its availability as an antiseptic, and a priori forbid
its use in all cases where the pulmonary processes are acutely
inflammatory in character. Fortunately, however, from a
clinical standpoint, pulmonary antisepsis is seldom so important
a factor in such cases as in the class where a mild stimulant or
even irritant effect is also desirable.
In looking over the reports for the past few years relative
to the therapeutic value of ozone, one is struck by the fact that
conclusions drawn from clinical work have been almost universally favorable, while laboratory investigators quite as uniformly deny its value as an antiseptic in any such proportions
as will admit of its use by inhalation. It seems possible to
reconcile these differences to a large degree if we admit the
value of ozone as a stimulant to local tissue activities, which in
themselves are strongly antiseptic, and equally possible to
believe that under the peculiar conditions of clinical use it
may, by reason of its multiple properties, produce results not
readily demonstrable by laboratory experiments. I have already expressed my own lack of faith in the power of any
available antiseptic to destroy bacilli in living tubercle tissue.
The only antiseptic action looked for has, therefore, been sought
in the effect of ozone inhalations upon the sputum. Examinations to determine its action upon tubercle bacilli, for which I

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387

am indebted to Dr. Egbert Lefevre, have thus far given negative

results, except Case II., referred to above. At the beginning
of treatment, and for some time previously, they were reported
as abundant. At the end of the month, when the cough and
expectoration had so markedly decreased, it required the preparation, at times, of two or three slides before they were
detected. It should be stated, in fairness, that all the other
cases tested were severe and in the later stages of the disease.
The effects of ozone, as thus far demonstrated, upon the tubercle
bacilli in the sputum are, therefore, only suggestive and not
absolute.
This clinical observation, that the amount of ozone Which
can be inhaled without undue irritation varies quite directly
with the amount and consistence of the sputum, certainly indicates that some of the force of the ozone is spent in modifying
the sputum.
In attempting to estimate the influence of ozone upon septic
decomposition the temperature has been taken as affording the
most accurate index. It is evident that the stimulant effect
upon pulmonary circulation, as well as any possible systemic
action, will be a factor in modifying the temperature; but as we
are looking for clinical results the particular factors in the
result are less important. In the cases treated by ozone alone
there was a prompt and decided reduction of temperature,
notably so in Case II., in which within the month it was
reduced from an average afternoon temperature of 1010 F. to
a fraction over 990 F., as reported by the attending physician.
It is fully recognized that the number of cases observed is,
as yet, far too small to permit any specific deductions, more
especially as the effect of the cabinet treatment, which was used
in conj unction with ozone in all the cases except two, is directly
in the line of temperature modification. The only statement
which I would make regarding this action of ozone must be an
expression of a belief that in these cases the fever reduction
was measurably due to the ozone inhalations in all the cases,
as well as in the two treated by ozone alone.
3. Ozone as a source of 8y8temic oxidation.
Clima Soc

22

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CHARLES E. QUIMBY,

Expert testimony as to the possibility of increasing the

amount of oxygen in the blood by means of inhalations is
somewhat contradictory, laboratory and clinical results again
being apparently opposite. Gilman Thompson has stated
essentially that increase in the proportion of oxygen in the
inspired air is not followed by any appreciable increased absorption; at the same time, he admits the clinical value, of
oxygen inhalations in certain cases. Caille, on the other hand,
states that persistent inhalation of ozone is followed by distinct
and reasonably permanent increase of the oxyhaemoglobin.
When it is recalled that in the former case experimentation
was with healthy lungs and blood already carrying its full
complement of oxygen, while in the latter exactly opposite
conditions existed, the results no longer appear contradictory,
but together make evident the conditions under which inhalations of oxygen or ozone may be of value. Absorption of
oxygen is a vital rather than a simple chemical process, and
depends upon both supply and demand, and no increase in the
proportion of oxygen in the respired air can make the ratio
between the amount required by the system and the amount
absorbed greater than unity. It is evident that the established
ratio between supply and demand may be modified by changes
in either factor.
Given normal respiratory surfaces and the usual proportion
of oxygen in the inspired air, any- marked increase in the
receptive capacity of the blood, as from the administration of
iron or from any augmented consumption of oxygen, as in
febrile processes, at once lowers this ratio. It must be restored
by increased supply, either from more frequent respirations or
an increase in the proportion of oxygen in the air. Again,
with systemic demand unchanged, any restriction of respiratory
capacity, either by diminution of surface or retardation of the
blood current, will similarly affect oxygenation through the
factor supply. Here, also, the normal respiratory ratio may
be restored by increase of the percentage of oxygen inspired,
or by restoration of respiratory surface. Now, in phthisis
both factors are changed for the bad. The febrile processes

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and reparative activities create a greater demand for oxygen,

which the diminished respiratory areas and retarded circulation
are unable to supply. The conclusion, then, is strictly logical
that oxygen or ozone inhalations should be of value not only
in phthisis but in febrile conditions as well, and in all cases
where there is reduction of the respiratory ratio. Having been
convinced that our failures to obtain satisfactory results were
due to unreasonable expectations and illogical methods of
administration by large and consequently unassimilable doses,
my own experiments have been directed to determining the
value of an ozonized atmosphere, such as may be produced in
any apartment and in which a patient may spend his entire
time, when breathed under those modifications of pulmonary
circulation obtainable by means of the pneumatic cabinet.
This value was estimated by the effects on the respirations
in phthisis and on the assimilation of iron. rt may be said
generally that in all cases of phthisis the respirations were
decreased in number, while in the ozonized air, by varying
amounts, determined apparently by the conditions of the
respiratory surfaces. When this area was markedly circumscribed by consolidations or bronchial obstructions the decrease
amounted to several respirations per minute, which gradually
gave place to a sense of easy respiration and refreshment,
when, by use of the cabinet, the respiratory areas had been
restored sufficiently to bring the average respirations to
normal.
One case illustrating this point is so striking as to be worthy
of mention. The patient was a man, about twenty-eight years
of age, in the last stages of a fibroid phthisis involving both
lungs extensively, and with abundant pleuritic fibroses. At
the time of examination, after half an hour's rest, his respirations were thirty-eight per minute. At the end of ten minutes' immersion in the ozonized and rarefied air of the cabinet
they were twenty-three per minute. This without any cabinet
treatment, which was given later. Fifteen minutes after the
first combined cabinet and ozone treatment his respirations,
while sitting quietly, had risen to twenty-nine per minute.

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CHARLES E. QUIMBt,

After five daily treatments, his regular quiet respirations

ranged from nineteen to twenty-one per minute. Under these
conditions the same ozonized air as at first had but little effect
upon the number of respirations. He simply spoke of the air
as refreshing. This patient is failing rapidly, yet his respirations, when quiet, do not rise above twenty or twenty-two per
minute.
The influence of the combined cabinet and ozone treatment
upon the assimilation of iron has been noted carefully in but a
single case. A young man, aged thirty-five years, had, about
eighteen months previously, received cabinet treatment alone
for a few weeks, for the relief of an aortic regurgitation of
over seven years' duration. At various times during these
seven years he had attempted to take iron, but on each occasion
he was soon forced to give it up, on account of severe headaches.
His cardiac and arterial conditions were so much relieved by
the use of the cabinet that he resumed heavy business cares
and discontinued his visits. At that time no attempt was
made to renew the use of iron. His present course of treatment began as soon as he was able to leave his room after
a severe attack of cardiac irregularity and palpitation that
seemed to threaten acute dilatation. While still confined to
his room, but as the more urgent symptoms were relieved, he
renewed the attempt to take iron, but again was obliged to
desist. Shortly after resuming the use of the cabinet, but now
with the ozone added, he began taking one three-grain Blaud's
pill three times a day. The amount was gradually increased,
until, within three weeks, he was taking fifteen grains three
times a day. That amount he has now continued some four
weeks without the least discomfort or suggestion of headache,
although his use of the cabinet has been somewhat irregular of
late. The favorable influence of the cabinet treatment upon
his general and pulmonary circulation was undoubtedly a
factor in this result, yet it seems to me impossible to deny
value to the ozone as well. From the foregoing results the
following conclusions seem justified:
1. Whenever the systemic demands for oxygen are increased,

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341

such demand may be met by an increase in the proportion of

in the inspired air.
oxvgen
2. Whenever the supply of oxygen is decreased through
diminution of the respiratory areas or retarded pulmonary
circulation such supply may be restored in a similar manner.
3. Since in any case appropriation of oxygen is a constant
process, varying according to the immediate requirements of
the system, all therapeutic administration of oxygen should be
similarly varied, in amounts sufficient to meet immediate
demands and in a form most readily absorbed.
This implies for cases of phthisis an ozonized atmosphere, to
be breathed constantly, if possible.
4. Methods of administration should include such measures
as will modify favorably the other factors of systemic oxygenation-i. e., the circulation and the respiratory capacity.
While these conditions are fulfilled most completely by the
pneumatic cabinet, one cannot spend prolonged periods in that
instrument. We are, therefore, to derive the largest value
from ozone as a systemic remedy when it is used for purifying
and impregnating the air of apartments occupied by patients,
by night as well as by day. With the present cheap supply of
power this is perfectly feasible, not only in large institutions
but in private houses.
In summary, then, we say that ozone is, all in all, our most
valuable local pulmonary stimulant; that, as antiseptics go, it
is among the best and the most certain to reach the deeper
pulmonary spaces; that it is of decided value as a respiratory
food; that it is best administered for the first and second purposes by means of the pneumatic cabinet, and for the third by
constant inhalation in small proportions.

DISCUSSION.
DR. VON RuCK: The stimulating action of ozone upon the mucous
surfaces of the lung we can get from other agents requiring less
apparatus and more easily administered; for instance, chlorine gas or

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DISCUSSION.

turpentine preparations produce such an effect, which is sometimes

desirable.
The long-continued inhalation of ozone in closed apartments I do
not think would be a desirable method of procedure, and it will be
much better to let the patient inhale pure air, if possible, out of doors,
even if but little ozone is present. At Asheville, N. C., I have for
more than five years past made observations of the ozone present in
the air, and find, thus far, an average of about 50 per cent, of the
possible amount. Such an ozonized air is no doubt desirable, and is
one of the advantages in the climatic treatment of phthisis; and
climatic resorts where ozone is found to be present in appreciable
quantities should, other things being equal, have preference over such
where none or but little is found. In the meanwhile it will be of
interest to know whether the artificially produced ozone and its
administration, as proposed by Dr. Quimby, will prove a good substitute for the natural ozone, as we have it upon the Asheville plateau,
and, no doubt, in other localities in this country. I believe Dr.
Quimby's efforts are in the right direction, for even if the treatment
he proposes should be less advantageous than residence in an ozonized
mountain air, it will doubtless have some value, and since the great
majority of patients cannot go to the climates where ozone is naturally
present, anything that we can add to their prospects for improvement
at home is a gain and a help which we need.
We measure the relative amount by exposure to the air of specially
prepared slips of paper, which are charged with starch and iodide of
potash, upon the well-known fact that when such paper is made moist
after exposure, and if ozone is present, discoloration, from a slight
brownish color to almost black, occurs, the intensity of color depending on the amount of ozone present. If none is present, the paper
remains white, and by a graduated color scale, from 0 to 100, we
express the relative degree of discoloration, 100 showing the greatest
amount ever observed, when the paper turns black.
DR. HINSDALE: They are purely arbitrary means; we have no
definite measure, it is only a relative measure.
DR. PLATT: All knowledge is relative.
DR. VON Rucm: The amount of moisture in the atmosphere is
relative, and the amount of ozone in the air is also relative; there are
different degrees, and these degrees are conveniently expressed, as we
express relative humidity, by percentage.
In observations upon ozone made by me in Ohio I have never been
able to find more than 5 per cent., while in Asheville we frequently
have 75 and occasionally 90 and 100 per cent., and this percentage
seems to me just as valuable as though we expressed it by grains or
cubic inches. As a therapeutic agent, it is yet to be proven that
unusually large quantities artificially produced are as good or better

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than that furnished by Nature in certain localities where its influence

is conitinuous.
DR. QUIMBY: If we accept Dr. von Ruck's standard, the percentage produced by the ozone machine must be something like
20,000. There are, of course, methods of measuring the volume percentage of ozone, and the statement that the air of any locality contains 100 or even 50 per cent. of ozone is obviously unscientific, and
would be misleading were it not that its impossibility as a scientific
fact makes it evident that the estimate was made upon some arbitrary
standard. Dr. von Ruck's criticism of ozone as a local stimulant and
irritant, because other substances are also irritant, has no force, for
everyone understands that stimulants or irritants are selected quite
as much from what they do not do as what they do do. Ozone is our
best pulmonary local stimulant, because all its associated actions are
valuable.
I cannot admit that any amount of deep breathing would have
reduced the respirations as in the case cited; but even admitting that
it would, the fact is not pertinent to the point at issue, nor could it
detract from the results given as proof of the power of ozonized air to
increase the absorption of oxygen for systemic use. The patient was
breathing quietly, his respiratory areas were not increased, and only
an increased absorption of oxygen can account for the change in
respirations. I am glad to express my appreciation of the purity of
the air at Dr. von Ruck's place of residence. At the same time, I am
unable to appreciate what relation it has to the value of ozone inhalations under other circumstances. My argument as to the value of an
excess of ozone in the respired air, such as can be had only by artificial means, under certain conditions and for certain purposes, appears
to me to be unaffected by any statements regarding the nature of some
other form of ozone.